Medicare Annual Enrollment Important Medicare Updates for 2015

Medicare Annual Enrollment Important Medicare Updates for 2015

SHINE Overview n n SHINE stands for Serving the Health Insurance Needs of Everyone Provides free and unbiased insurance information and counseling to Medicare beneficiaries Over 600 SHINE counselors available throughout Massachusetts to help SHINE Counselors are available at many Senior Centers, Councils on Aging (COA), Community hospitals and many other community-based sites 2

2014– 2015 Important Dates Ø October 15 th 2014: Open Enrollment begins • Medicare beneficiaries can change health and prescription coverage Ø December 7 th 2014: Open Enrollment ends • Enrollment requests must be received by the 7 th Ø January 1 st 2015: Coverage begins 3

Your Medicare Coverage Choices Step 1: Decide how you want to get your coverage MEDICARE ADVANTAGE PLAN ORIGINAL MEDICARE PART A Hospital Insurance & PART B Medical Insurance OR PART C Combines Part A, Part B and usually Part D Step 2: Decide if you need a Prescription Drug Plan PART D Stand Alone PDP PART D Included in Part C Step 3: Decide if you need to add supplemental medical coverage MEDIGAP Supplement Core or Supplement 1 plan END If you join a Medicare Advantage Plan with drug coverage (MAPD), you cannot join another drug plan and you don’t need and cannot be sold a 4 Medigap policy

Part B Preventive Benefits § ACA provides access to many free preventive benefits • Mammograms • Some pap smear and pelvic exams • Colorectal Screenings • Diabetes Self-Management Training/Tests • Bone Mass Measurements • Prostate Cancer Screening • Obesity screening/counseling • Depression screening/counseling • Annual Wellness Visit Update individual’s medical & family history Ø Record height, weight, body mass index, blood pressure and other routine measurements Ø Provide personal health advice and coordinate appropriate referrals 5 and health education Ø

Open Enrollment Options n If in a Medicare Advantage (MA) plan: • Can change to a different MA plan • Can change to Original Medicare and enroll in a Part D (along with a Medigap, if desired) Ø Members of MA plans must have Medicare Parts A & B and must continue to pay the Part B premium n n If in Original Medicare: • Can enroll in an MA plan If in a Part D plan: • Can drop or switch Part D plans 6

Medicare Supplement Plans 2015 n Supplement Plans (Medigaps) • Sold by private insurance companies • Coverage varies for deductibles and co-insurance • No network restrictions • Drug coverage is NOT included n 2015 updates • Continuous open enrollment • If changing plans, cancel enrollment in old plan 7

Medicare Advantage Plans 2015 n MA plans (HMO’s, PPO’s) • Coverage provided through private plans within networks • Prescription drug coverage usually included n 2015 Updates • Plan changes will be announced to members on September 25 th 8

Medicare Supplement vs. Medicare Advantage 9

Medicare Prescription Drug Coverage n Also called Part D n Provides outpatient prescription drugs n All Medicare beneficiaries are eligible • Can have Part A and/or Part B n Coverage for Part D is provided by: • Prescription Drug plans (PDP’s), also known as stand alone plans • Medicare Advantage Prescription Drug Plans (MAPD’s) 10

Anatomy of a Drug Plan n Cost components • Premiums: Monthly cost • Deductibles: Annual cost • Co-pays and co-insurance: Paid at pharmacy • Formularies: List of medications covered • Drug tiers: Pricing ladder • Restrictions: Quantity limits, prior authorization, or step therapy n Amounts change periodically, therefore it is important to review coverage during Open Enrollment 11

Part D Coverage 2014 vs. 2015 Standard Coverage Levels 2014 2015 Deductible $310 $320 Initial Coverage Limit $2, 850 $2, 960 “Out-of-pocket” Threshold $4, 550* $4, 700* Catastrophic Cost-sharing 5% or $2. 55/$6. 35 5% or $2. 65/$6. 60 * In 2015, after $2, 960 in retail costs, the beneficiary pays 45% of brand name drug costs and 65% of generic drug costs until total out-ofpocket costs equal $4, 700 12

Part D Changes for 2015 n Plan changes announced September 25 th n Important to compare plans every year 13

Assistance Programs May Help n There are several assistance programs to help pay Medicare cost-sharing including: • Extra Help (Low Income Subsidy/LIS) • Prescription Advantage • Patient Access Programs • See handout “Concerned about Medicare Costs? ” n n These programs are based on income and/or assets A SHINE Counselor can help you determine which programs you may qualify for and assist you in applying 14

Resources n SHINE: 1 -800 -AGE-INFO (1 -800 -243 -4636), press 3 n Medicare: 1 -800 -MEDICARE (1 -800 -633 -4227) n MCPHS Pharmacy Outreach Program: 1 -800 -633 -1617 n Prescription Advantage: 1 -800 -AGE-INFO, press 2 n Medicare Advocacy Project (MAP): 1 -866 -778 -0939 n Senior Medicare Patrol: 1 -800 -892 -0890 15

Remember! n This is the time of year to make changes to your Medicare Advantage or Prescription Drug Plan n Ask yourself: ® Will my plan cover the drugs I take? ® How much will my plan cost? ® Will my doctor/hospital take my Medicare Advantage Plan? 16